Secure arm positioning is used typically during procedures such as, but not limited to, lithotomy based, laparascopic, daVinci robot or other indicated surgical cases where the surgeon or procedure necessitates that the arms of the patient be placed against the patient's body in order to adequately access the surgical field.
There have been many research articles written on the subject of patient upper extremity nerve, vascular, or skin integrity injuries occurring during different surgical procedures. These injuries may occur under numerous circumstances, and sometimes despite proper stowing techniques, injuries may still result.
There are a few factors that contribute to these type of injuries. The patient's body habitus or size with regard to obesity or extreme instances of frailty may play a significant role in the increased incidence of injuries. Extremely thin, elderly or emaciated individuals with thin arms, lack of adipose tissue, and overt bony prominences may pose problems despite best efforts to protect the upper extremities.
One example of an accepted positioning standard is the use of padding and a draw sheet (sheet folded under the patient) to tuck and stow an arm during a surgical procedure. The purpose of the draw sheet is to use the patient's own distributed weight to hold the sheet and arm in place while the arm is wrapped. While this technique is currently the standard of care accepted by many practitioners, there are some drawbacks. The use of draw sheets can cause potential injuries when the patient's weight is used to secure the arm. For example, during extreme table positioning, the patient's weight is unevenly distributed thereby potentially causing a tourniquet, or tightening effect that may cause damage despite adequate use of padding. These types of injuries related to arm tucking may also increase depending on the amount of time that the patient is undergoing the procedure.
While most patients have no problem with accepted stowing practices, there has been a significant shift in patient population due to an increase in co-morbidities, especially with respect to body size (obesity). When a larger patient is laying on a table that does not fully account for the girth of the patient, this decreases the surface area of the table that is available to stow the arms correctly at the patient's side because of the reduction of the surface area of the table available for the arms to securely rest on.
There are a few existing devices that may be used. For example, a standard arm-board may be placed at the patient's side perpendicular to the direction of the table. The problem with the linear-placed arm-board is that the surgeon or surgical staff must reach over a larger surface area with regard to the arm-board's position to reach the surgical field.
Another device is a sled-type device that slides under the mattress of the operating table thereby using the weight of the patient to secure the patient's arm closer to their body. The sled-type device may be difficult to place under a patient-weighted mattress. Hospital mattresses are typically tethered to the mattress frame with hook and loop fasteners. The hook and loop fasteners are placed in the midportion of the underside of the mattress, and these fasteners help secure the mattress to the frame. Theoretically, any disruption with regard to the hook and loop fasteners caused by the sled could cause movement of the mattress and/or patient during extreme surgical table positions resulting in injury. The sleds can also potentially rip the mattress because the sled is forced under a weighted (from the patient's own weight) mattress thereby causing potential tears in the fabric covering the mattress. These tears can ruin the integrity of the mattress which could then become a potential place for bodily fluids, blood, or other biohazard materials to collect during surgical procedures, thereby increasing the opportunity for cross infection to both patients and staff.
What is needed is an arm tucking device with a low profile that prevents injuries and is suitable for use with a wide variety of patients.